Mucormycosis is a progressive, opportunistic fungal infection with high risk of mortality. Rampant use of steroids in the treatment coronavirus disease 2019 creates a fertile environment for mucor growth. Perioperative challenges for the anesthesiologist in a patient having post-coronavirus disease mucormycosis include increased risks of arterial and venous thromboembolism, poor glycemic control and myocardial dysfunction, adrenal insufficiency from corticosteroid use, pulmonary dysfunction, and residual neuromuscular weakness. So, a complete biochemical workup of renal functions, hypothalamic–pituitary–adrenal axis, electrolyte, coagulation profile, optimization of blood glucose, and pulmonary function should be done.
{"title":"Perioperative Anaesthetic challenges during the management of Mucormycosis in a recovered SARS-CoV-2 Patient: A Case report","authors":"Sarfaraz Ahmad, Neeraj Kumar, Amarjit Kumar, Mithun Rathinasamy","doi":"10.4103/roaic.roaic_10_22","DOIUrl":"https://doi.org/10.4103/roaic.roaic_10_22","url":null,"abstract":"Mucormycosis is a progressive, opportunistic fungal infection with high risk of mortality. Rampant use of steroids in the treatment coronavirus disease 2019 creates a fertile environment for mucor growth. Perioperative challenges for the anesthesiologist in a patient having post-coronavirus disease mucormycosis include increased risks of arterial and venous thromboembolism, poor glycemic control and myocardial dysfunction, adrenal insufficiency from corticosteroid use, pulmonary dysfunction, and residual neuromuscular weakness. So, a complete biochemical workup of renal functions, hypothalamic–pituitary–adrenal axis, electrolyte, coagulation profile, optimization of blood glucose, and pulmonary function should be done.","PeriodicalId":151256,"journal":{"name":"Research and Opinion in Anesthesia and Intensive Care","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"123065497","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-01-01DOI: 10.4103/roaic.roaic_38_22
N. Sasikumar, S. Rajan, V. Ravindran, Naveen Karthik
{"title":"Ala nasi pressure sore following nasotracheal intubation","authors":"N. Sasikumar, S. Rajan, V. Ravindran, Naveen Karthik","doi":"10.4103/roaic.roaic_38_22","DOIUrl":"https://doi.org/10.4103/roaic.roaic_38_22","url":null,"abstract":"","PeriodicalId":151256,"journal":{"name":"Research and Opinion in Anesthesia and Intensive Care","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"121166635","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-01-01DOI: 10.4103/roaic.roaic_41_15
S. Omar, Monir Afifi, Mohamed Abd Elhady, Ahmed Elkader Mahmoud
Background The objective of this randomized double blind study was to evaluate the effect of preoperative single oral dose of pregabalin 150 mg on pain sensitivity, postoperative hyperalgsia and opioid consumption after total abdominal hysterectomy. Purpose The aim of this study was to evaluate the effect of preoperative single oral dose of pregabalin on pain sensitivity, postoperative hyperalgsia and opioid consumption after total abdominal hysterectomy. Patients and methods Sixty female patients were randomly categorized into two equal groups (30 patients each): group I, patients received pregabalin 150 mg orally, 1 h before induction of anaesthesia. Group II, patients received a matching placebo orally, 1 h before induction of anaesthesia, then evaluation of postoperative analgesia by visual analogue scale score, postoperative hyperalgesia using von Frey filaments and opioid consumption for 24 h was carried out. Conclusion From the primary endpoints assessed in this work, one can declare that usage of pregabalin in a dose of 150 mg, was more effective in reducing hemodynamic changes, postoperative pain intensity, hyperalgesia and analgesic consumption in comparison with a placebo as pre-emptive analgesia, when neither doses caused respiratory depression or sedation or PONV, but found also to significantly increase postoperative side effects including dizziness and somnolence as a secondary endpoint assessed.
{"title":"Effects of single preoperative oral pregabalin administration on postoperative hyperalgesia and opioid consumption after total abdominal hysterectomy","authors":"S. Omar, Monir Afifi, Mohamed Abd Elhady, Ahmed Elkader Mahmoud","doi":"10.4103/roaic.roaic_41_15","DOIUrl":"https://doi.org/10.4103/roaic.roaic_41_15","url":null,"abstract":"Background The objective of this randomized double blind study was to evaluate the effect of preoperative single oral dose of pregabalin 150 mg on pain sensitivity, postoperative hyperalgsia and opioid consumption after total abdominal hysterectomy. Purpose The aim of this study was to evaluate the effect of preoperative single oral dose of pregabalin on pain sensitivity, postoperative hyperalgsia and opioid consumption after total abdominal hysterectomy. Patients and methods Sixty female patients were randomly categorized into two equal groups (30 patients each): group I, patients received pregabalin 150 mg orally, 1 h before induction of anaesthesia. Group II, patients received a matching placebo orally, 1 h before induction of anaesthesia, then evaluation of postoperative analgesia by visual analogue scale score, postoperative hyperalgesia using von Frey filaments and opioid consumption for 24 h was carried out. Conclusion From the primary endpoints assessed in this work, one can declare that usage of pregabalin in a dose of 150 mg, was more effective in reducing hemodynamic changes, postoperative pain intensity, hyperalgesia and analgesic consumption in comparison with a placebo as pre-emptive analgesia, when neither doses caused respiratory depression or sedation or PONV, but found also to significantly increase postoperative side effects including dizziness and somnolence as a secondary endpoint assessed.","PeriodicalId":151256,"journal":{"name":"Research and Opinion in Anesthesia and Intensive Care","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"130377614","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-01-01DOI: 10.4103/roaic.roaic_22_22
Islam Ahmed, Hesham M Hefny, Amal Ali, B. Refaie, Khalid Abdelal, E. Taha
Background Inflammatory markers like interleukin-6 (IL-6) are linked to the worse outcome in coronavirus disease 2019 (COVID-19) cases. Other markers such as C-reactive protein are not as reliable as IL-6 in predicting respiratory failure. Aim To assess the function of IL-6 as a predictor of COVID-19 severity. Patients and methods A total of 50 severe and critical patients with PCR-confirmed COVID-19 were included. All enrolled patients followed the case definition for confirmed cases of Egyptian national protocol for COVID-19 issued by MOHP. Clinical assessment, imaging, and laboratory data were recorded at admission. Pulmonary function was evaluated by SpO2/FiO2 ratio. Outcomes included hospital stay, prognosis of the disease, complications, death rate, and discharge, which were recorded during the follow-up. Results The elevated IL-6 group showed a significantly higher critical rate (87.1%) than the normal IL-6 group (26.3%) (P<0.0001), and the improvement rate was higher in the normal IL-6 group (73.7%). Moreover, the death rate was significantly greater in the elevated IL-6 group (38.7%) than the normal IL-6 group (10.5%) (P=0.033). The cutoff value of IL-6 levels in prediction of severity and mortality of COVID-19 was assessed. Our receiver operating characteristic results revealed that IL-6 cutoff value is higher than 50.27 for severity and the cutoff value is greater than 120.83 for mortality. The sensitivity values of IL-6 for severity and mortality were 93.3 and 90.5%, respectively, and the specificity values were 90.0 and 86.7%, respectively. Conclusion Elevated levels of serum IL-6 in COVID-19-infected patients were related with a variety of adverse outcomes, including severe illness, mechanical ventilation, and acute respiratory distress syndrome. When it came to accurately predicting the severity and mortality of COVID-19, the optimum IL-6 cutoff levels were 50.27 and 120.83 pg/ml, respectively.
{"title":"Serum interleukin-6 as a predictor of the severity of coronavirus disease 2019","authors":"Islam Ahmed, Hesham M Hefny, Amal Ali, B. Refaie, Khalid Abdelal, E. Taha","doi":"10.4103/roaic.roaic_22_22","DOIUrl":"https://doi.org/10.4103/roaic.roaic_22_22","url":null,"abstract":"Background Inflammatory markers like interleukin-6 (IL-6) are linked to the worse outcome in coronavirus disease 2019 (COVID-19) cases. Other markers such as C-reactive protein are not as reliable as IL-6 in predicting respiratory failure. Aim To assess the function of IL-6 as a predictor of COVID-19 severity. Patients and methods A total of 50 severe and critical patients with PCR-confirmed COVID-19 were included. All enrolled patients followed the case definition for confirmed cases of Egyptian national protocol for COVID-19 issued by MOHP. Clinical assessment, imaging, and laboratory data were recorded at admission. Pulmonary function was evaluated by SpO2/FiO2 ratio. Outcomes included hospital stay, prognosis of the disease, complications, death rate, and discharge, which were recorded during the follow-up. Results The elevated IL-6 group showed a significantly higher critical rate (87.1%) than the normal IL-6 group (26.3%) (P<0.0001), and the improvement rate was higher in the normal IL-6 group (73.7%). Moreover, the death rate was significantly greater in the elevated IL-6 group (38.7%) than the normal IL-6 group (10.5%) (P=0.033). The cutoff value of IL-6 levels in prediction of severity and mortality of COVID-19 was assessed. Our receiver operating characteristic results revealed that IL-6 cutoff value is higher than 50.27 for severity and the cutoff value is greater than 120.83 for mortality. The sensitivity values of IL-6 for severity and mortality were 93.3 and 90.5%, respectively, and the specificity values were 90.0 and 86.7%, respectively. Conclusion Elevated levels of serum IL-6 in COVID-19-infected patients were related with a variety of adverse outcomes, including severe illness, mechanical ventilation, and acute respiratory distress syndrome. When it came to accurately predicting the severity and mortality of COVID-19, the optimum IL-6 cutoff levels were 50.27 and 120.83 pg/ml, respectively.","PeriodicalId":151256,"journal":{"name":"Research and Opinion in Anesthesia and Intensive Care","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"122736404","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-01-01DOI: 10.4103/roaic.roaic_22_17
Mohamed Abd Elhady, A. Mehanna, N. Maged
Background The use of epidural analgesia for the management of postoperative pain has evolved as a critical component of multimodal approach to achieve the goal of adequate analgesia with improved outcome. The introduction of ultrasound technology for epidural insertion presents a novel challenge of acquiring new knowledge and skill set. As with acquiring any new skill, there will be initial challenges for both the novice and experienced anesthesiologist. From correlating anatomy with sonoanatomy and visualizing needles and fluid dynamics in real-time below the skin surface, ultrasound provides opportunities and unique challenges for vascular access and regional anesthesia. Purpose The purpose of this study was to evaluate the utility of ultrasound in the process of epidural catheter inserion and whether it can replace the conventional loss-of-resistance (LOS) technique or at least help with better performance by the staff. Patients and methods A total of 30 patients scheduled for thoracotomy were randomly categorized by closed envelopes method into two equal groups (15 patients each): group I patients received epidural anesthesia with ultasound guidance, and group II patients received epidural anesthesia with the conventional palpation technique. We recorded time from first puncture till LOS, number of skin punctures till LOS, redirections, and bone contacts. Failure and complications were recorded as well. Patient satisfaction was assessed after catheter insertion and removal, which was 24 h postoperatively in the postanesthesia care unit. Results A significant increase in insertion time was recorded in group I (P<0.001). The number of skin punctures till LOS was significantly lower in group I (P=0.043), and needle redirections were also lower in group I (P=0.020). Vertebrae were less hit by the needle in group I (P=0.026). A case of epidural failure was recorded in group II, and also an accidental hemorrhagic tap was recorded in the same group. Patient satisfaction both after catheter insertion and removal was higher in group I (P=0.031 and 0.002, respectively). Conclusion From the primary endpoints assessed in this work, one can declare that usage of ultrasound had consumed time owing to lack of experience by the operator, yet it led to less puncture attempts, redirections, and bone contacts and reduced failure rates and complication rates, which led to increased satisfaction. The technique requires more practice and training to familiarize anesthesia staff with it to lower the procedure time.
{"title":"A randomized controlled study comparing the use of ultrasound versus the conventional method in thoracic epidural catheter insertion as a pain relief method in thoracic surgeries","authors":"Mohamed Abd Elhady, A. Mehanna, N. Maged","doi":"10.4103/roaic.roaic_22_17","DOIUrl":"https://doi.org/10.4103/roaic.roaic_22_17","url":null,"abstract":"Background The use of epidural analgesia for the management of postoperative pain has evolved as a critical component of multimodal approach to achieve the goal of adequate analgesia with improved outcome. The introduction of ultrasound technology for epidural insertion presents a novel challenge of acquiring new knowledge and skill set. As with acquiring any new skill, there will be initial challenges for both the novice and experienced anesthesiologist. From correlating anatomy with sonoanatomy and visualizing needles and fluid dynamics in real-time below the skin surface, ultrasound provides opportunities and unique challenges for vascular access and regional anesthesia. Purpose The purpose of this study was to evaluate the utility of ultrasound in the process of epidural catheter inserion and whether it can replace the conventional loss-of-resistance (LOS) technique or at least help with better performance by the staff. Patients and methods A total of 30 patients scheduled for thoracotomy were randomly categorized by closed envelopes method into two equal groups (15 patients each): group I patients received epidural anesthesia with ultasound guidance, and group II patients received epidural anesthesia with the conventional palpation technique. We recorded time from first puncture till LOS, number of skin punctures till LOS, redirections, and bone contacts. Failure and complications were recorded as well. Patient satisfaction was assessed after catheter insertion and removal, which was 24 h postoperatively in the postanesthesia care unit. Results A significant increase in insertion time was recorded in group I (P<0.001). The number of skin punctures till LOS was significantly lower in group I (P=0.043), and needle redirections were also lower in group I (P=0.020). Vertebrae were less hit by the needle in group I (P=0.026). A case of epidural failure was recorded in group II, and also an accidental hemorrhagic tap was recorded in the same group. Patient satisfaction both after catheter insertion and removal was higher in group I (P=0.031 and 0.002, respectively). Conclusion From the primary endpoints assessed in this work, one can declare that usage of ultrasound had consumed time owing to lack of experience by the operator, yet it led to less puncture attempts, redirections, and bone contacts and reduced failure rates and complication rates, which led to increased satisfaction. The technique requires more practice and training to familiarize anesthesia staff with it to lower the procedure time.","PeriodicalId":151256,"journal":{"name":"Research and Opinion in Anesthesia and Intensive Care","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"124412674","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-01-01DOI: 10.4103/roaic.roaic_46_22
A. Hassanin, N. Ali, Emad Abd El naeem, M. Mahran
Background/aim Mortality and morbidity in traumatic brain injury (TBI) patients are still high. Understanding the role of new treatments in these patients is critical. So the potential role of simvastatin in the treatment of TBI patients was examined in this research. Methods 40 patients with acute TBI who were admitted to the ICU were split into two groups; the control group received standard care and head trauma protocol medications for 7 days, while the study group also received standard care and head trauma protocol medications but also received simvastatin 80 mg the first day and 40 mg every day for 6 days. ICU duration of stay and mortality, Acute Physiology and Chronic Health Evaluation II score, Glasgow coma scale, amyloid precursor protein serum level at admission, 3 and 5 days after admission, and Glasgow outcome scale at discharge, 3 and 6 months after discharge were all noted. Results We found that the simvastatin group’s Acute Physiology and Chronic Health Evaluation II score at discharge had decreased significantly. The simvastatin group also showed greater Glasgow coma scale improvement beginning on day 3 of admission and continuing until day 7. When compared with the control group, simvastatin-treated patients had significantly lower levels of amyloid precursor protein on the third and fifth days of hospitalization. Patients using simvastatin had better Glasgow outcome scale results as compared with the control group. Conclusion We concluded that simvastatin has a promising effect in individuals with acute TBI.
{"title":"Efficacy of simvastatin in treating patients with traumatic brain injury","authors":"A. Hassanin, N. Ali, Emad Abd El naeem, M. Mahran","doi":"10.4103/roaic.roaic_46_22","DOIUrl":"https://doi.org/10.4103/roaic.roaic_46_22","url":null,"abstract":"Background/aim Mortality and morbidity in traumatic brain injury (TBI) patients are still high. Understanding the role of new treatments in these patients is critical. So the potential role of simvastatin in the treatment of TBI patients was examined in this research. Methods 40 patients with acute TBI who were admitted to the ICU were split into two groups; the control group received standard care and head trauma protocol medications for 7 days, while the study group also received standard care and head trauma protocol medications but also received simvastatin 80 mg the first day and 40 mg every day for 6 days. ICU duration of stay and mortality, Acute Physiology and Chronic Health Evaluation II score, Glasgow coma scale, amyloid precursor protein serum level at admission, 3 and 5 days after admission, and Glasgow outcome scale at discharge, 3 and 6 months after discharge were all noted. Results We found that the simvastatin group’s Acute Physiology and Chronic Health Evaluation II score at discharge had decreased significantly. The simvastatin group also showed greater Glasgow coma scale improvement beginning on day 3 of admission and continuing until day 7. When compared with the control group, simvastatin-treated patients had significantly lower levels of amyloid precursor protein on the third and fifth days of hospitalization. Patients using simvastatin had better Glasgow outcome scale results as compared with the control group. Conclusion We concluded that simvastatin has a promising effect in individuals with acute TBI.","PeriodicalId":151256,"journal":{"name":"Research and Opinion in Anesthesia and Intensive Care","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"121649213","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-01-01DOI: 10.4103/roaic.roaic_57_22
Fouad Soliman, A. Hassan, M. Mahmoud, B. Refaie
Background Thyroidectomy operation is considered a common operation done nowadays. Pain after thyroidectomy is moderate to severe in some patients. Many techniques are used to provide analgesia and to avoid opioid adverse effects such as local wound infiltration, and regional anesthesia techniques like bilateral superficial cervical plexus block (BSCPB), alone or in combination with deep cervical plexus block. Patients and methods In this prospective, randomized, and double‑blind study, 46 patients were randomly allocated into two equal groups (23 in each group): the bupivacaine group (group B) received BSCPB with 10 ml of 0.25% bupivacaine and 1 ml normal saline on each side and the bupivacaine ketorolac group (group BK) received 10 ml of 0.25% bupivacaine and 1 ml ketorolac (15 mg) on each side. The first-time supplemental analgesia needed postoperatively was our primary outcome. Secondary outcomes include total analgesic consumption, visual analog score, patient satisfaction, and adverse effects. Results visual analog score at 8, 16, and 24 h and total ketorolac requirements were significantly lower (P=0.001 and 0.02, respectively), whereas the time to first rescue analgesic requirement was significantly longer in group BK when compared with group B (P=0.001). The frequency of nausea and vomiting was not statistically significant with less incidence in group BK compared with group B. Throat pain frequency was significantly less in group BK (P=0.05). Patient satisfaction was statistically significant in group BK (P=0.03). Conclusion Adding ketorolac to bupivacaine in BSCPB improved the control of pain, increased the pain-free period, decreased postoperative analgesic needs, and decreased adverse effects.
{"title":"The use of ketorolac as an adjuvant in the superficial cervical plexus block","authors":"Fouad Soliman, A. Hassan, M. Mahmoud, B. Refaie","doi":"10.4103/roaic.roaic_57_22","DOIUrl":"https://doi.org/10.4103/roaic.roaic_57_22","url":null,"abstract":"Background Thyroidectomy operation is considered a common operation done nowadays. Pain after thyroidectomy is moderate to severe in some patients. Many techniques are used to provide analgesia and to avoid opioid adverse effects such as local wound infiltration, and regional anesthesia techniques like bilateral superficial cervical plexus block (BSCPB), alone or in combination with deep cervical plexus block. Patients and methods In this prospective, randomized, and double‑blind study, 46 patients were randomly allocated into two equal groups (23 in each group): the bupivacaine group (group B) received BSCPB with 10 ml of 0.25% bupivacaine and 1 ml normal saline on each side and the bupivacaine ketorolac group (group BK) received 10 ml of 0.25% bupivacaine and 1 ml ketorolac (15 mg) on each side. The first-time supplemental analgesia needed postoperatively was our primary outcome. Secondary outcomes include total analgesic consumption, visual analog score, patient satisfaction, and adverse effects. Results visual analog score at 8, 16, and 24 h and total ketorolac requirements were significantly lower (P=0.001 and 0.02, respectively), whereas the time to first rescue analgesic requirement was significantly longer in group BK when compared with group B (P=0.001). The frequency of nausea and vomiting was not statistically significant with less incidence in group BK compared with group B. Throat pain frequency was significantly less in group BK (P=0.05). Patient satisfaction was statistically significant in group BK (P=0.03). Conclusion Adding ketorolac to bupivacaine in BSCPB improved the control of pain, increased the pain-free period, decreased postoperative analgesic needs, and decreased adverse effects.","PeriodicalId":151256,"journal":{"name":"Research and Opinion in Anesthesia and Intensive Care","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"120969071","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-01-01DOI: 10.4103/roaic.roaic_37_22
B. Refaie, Islam Ahmed, A. Hassan, Fouad Soliman, A. Abdelkareem
Introduction Ilioinguinal and iliohypogastric (IIIH) nerve blocks help to manage postoperative pain that occurs following inguinal hernia repair or varicocelectomy. Aim The study aimed to compare the effect of adding magnesium sulfate or dexamethasone to levobupivacaine for iliohypogastric and ilioinguinal nerve blocks, in terms of postoperative analgesic length, visual analog scale ratings, first analgesic requirements, and hemodynamic changes. Patients and methods The study included 86 patients, aged 20–70 years, who were divided into two groups (D and M). Patients in group D received 9 ml of 0.5% levobupivacaine for the nerve block plus 1 ml dexamethasone (8 mg), whereas patients in group M received 9 ml 0.5% levobupivacaine plus 1 ml magnesium sulfate 10% (100 mg). Postoperative analgesia, visual analog scale scores, and any complications were documented. Results Group D had a significantly longer analgesic time. A significantly lower amount of analgesic was consumed on the first postoperative day with significantly low pain score as compared with group M. Conclusion The addition of dexamethasone to levobupivacaine for IIIH nerve blocks improved the postoperative analgesia.
{"title":"Magnesium sulfate versus dexamethasone as an adjuvant in the ilioinguinal and iliohypogastric nerve blocks","authors":"B. Refaie, Islam Ahmed, A. Hassan, Fouad Soliman, A. Abdelkareem","doi":"10.4103/roaic.roaic_37_22","DOIUrl":"https://doi.org/10.4103/roaic.roaic_37_22","url":null,"abstract":"Introduction Ilioinguinal and iliohypogastric (IIIH) nerve blocks help to manage postoperative pain that occurs following inguinal hernia repair or varicocelectomy. Aim The study aimed to compare the effect of adding magnesium sulfate or dexamethasone to levobupivacaine for iliohypogastric and ilioinguinal nerve blocks, in terms of postoperative analgesic length, visual analog scale ratings, first analgesic requirements, and hemodynamic changes. Patients and methods The study included 86 patients, aged 20–70 years, who were divided into two groups (D and M). Patients in group D received 9 ml of 0.5% levobupivacaine for the nerve block plus 1 ml dexamethasone (8 mg), whereas patients in group M received 9 ml 0.5% levobupivacaine plus 1 ml magnesium sulfate 10% (100 mg). Postoperative analgesia, visual analog scale scores, and any complications were documented. Results Group D had a significantly longer analgesic time. A significantly lower amount of analgesic was consumed on the first postoperative day with significantly low pain score as compared with group M. Conclusion The addition of dexamethasone to levobupivacaine for IIIH nerve blocks improved the postoperative analgesia.","PeriodicalId":151256,"journal":{"name":"Research and Opinion in Anesthesia and Intensive Care","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"126956664","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-01-01DOI: 10.4103/roaic.roaic_48_22
Amr El-Morsy, A. Dahroug, Asmaa Ali
Introduction Sepsis is a medical life-threatening emergency that involves dysfunction of an organ induced by the host’s dysregulated extreme response toward an infection. Sepsis is prominent worldwide causing septic mortality and numerous critical illnesses. Septic shock is defined as severe persisting hypotension that is induced by sepsis although there is an adequate resuscitation of fluids. Objective This study aim was to assess the use of central venous catheter (CVC) and peripheral (external jugular) vein for low or moderate doses of noradrenaline regarding the outcome of septic shock among patients who are diagnosed with critical illnesses. Patients and methods This study is a prospective cohort study involving 120 patients according to sample size calculation with septic shock who were sorted randomly into two groups. Group I (the group involving the external jugular): 60 patients experienced septic shock and received low or moderate doses of noradrenaline in the external jugular vein. Group II (CVC group): 60 patients diagnosed with septic shock and received low or moderate noradrenaline doses in the CVC. Results Low or moderate doses of noradrenaline in the jugular line was associated with significantly higher blood pressure on day 7, and lower Sequential Organ Failure Assessment Score on days 5 and 7 than the CVC group. There was a difference that is statistically significant between ICU-involved duration of stay among the two involved study groups as it was found lower significantly among the jugular group. Conclusion Low or moderate doses of noradrenaline can be administered safely within the peripheral line (jugular) in patients with septic shock with minor complications causing a decrease in the duration of ICU stay.
{"title":"Effect of noradrenaline infusion in central venous catheter versus external jugular vein on the outcome of septic shock patients","authors":"Amr El-Morsy, A. Dahroug, Asmaa Ali","doi":"10.4103/roaic.roaic_48_22","DOIUrl":"https://doi.org/10.4103/roaic.roaic_48_22","url":null,"abstract":"Introduction Sepsis is a medical life-threatening emergency that involves dysfunction of an organ induced by the host’s dysregulated extreme response toward an infection. Sepsis is prominent worldwide causing septic mortality and numerous critical illnesses. Septic shock is defined as severe persisting hypotension that is induced by sepsis although there is an adequate resuscitation of fluids. Objective This study aim was to assess the use of central venous catheter (CVC) and peripheral (external jugular) vein for low or moderate doses of noradrenaline regarding the outcome of septic shock among patients who are diagnosed with critical illnesses. Patients and methods This study is a prospective cohort study involving 120 patients according to sample size calculation with septic shock who were sorted randomly into two groups. Group I (the group involving the external jugular): 60 patients experienced septic shock and received low or moderate doses of noradrenaline in the external jugular vein. Group II (CVC group): 60 patients diagnosed with septic shock and received low or moderate noradrenaline doses in the CVC. Results Low or moderate doses of noradrenaline in the jugular line was associated with significantly higher blood pressure on day 7, and lower Sequential Organ Failure Assessment Score on days 5 and 7 than the CVC group. There was a difference that is statistically significant between ICU-involved duration of stay among the two involved study groups as it was found lower significantly among the jugular group. Conclusion Low or moderate doses of noradrenaline can be administered safely within the peripheral line (jugular) in patients with septic shock with minor complications causing a decrease in the duration of ICU stay.","PeriodicalId":151256,"journal":{"name":"Research and Opinion in Anesthesia and Intensive Care","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"114095420","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-01-01DOI: 10.4103/roaic.roaic_84_21
I. Nour, Khalaf Eldehily, A. A. Abd Elbaset, H. Saber
Introduction Mechanisms of acute kidney injury (AKI) comprise renal hypoperfusion, intrarenal vasoconstriction, inflammation, oxidative stress, and nephrotoxicity. An important pathophysiological pathway includes intrarenal vasoconstriction and endothelial damage of the microvessel, leading to impaired macrovascular and microvascular flow, which further aggravates ischemia. Nowadays, Doppler ultrasound is rapidly gaining ground as a screening tool in critically ill patients. The performance of cardiac, lung, and abdominal ultrasound in patients after cardiac arrest, major operations, and during shock has become the standard policy. However, renal ultrasound, which could be easily incorporated in this screening, is not commonly performed. Aim To test the ability of renal resistive index (RRI) measurement by Doppler ultrasound to predict the development of AKI in septic patients and find a relation with the progression to persistent renal impairment and relation to outcome and mortality. Patients and methods A total of 40 septic patients with AKI were randomized and subjected to RRI measurements, on admission and after 48 h, and the patients were followed till hospital discharge to detect the correlation to outcome. Mortality risk assessment was measured by the APACHE III score. Results There was a statistically significant increase of RRI in cases with persistent AKI in comparison with cases with transient AKI (P<0.05). There was a statistically significant increase in APACHE III score in patients with high RI (P<0.005). Conclusion Renal Doppler RI may be a promising tool for predicting the risk of developing AKI in acutely ill septic patients and may help in predicting the reversibility of AKI. High RRI values in septic patients with AKI are independently related to ICU mortality and persistent renal dysfunction at discharge from ICU.
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